Objective:To explore the clinical effect of laparoscopic high ligation of inguinal hernia sac in children with veress needle and semi-rigid biopsy forceps.Methods:121 cases of indirect hernia of groin admitted in Rugao People's Hospital from June 2018 to November 2019 were analyzed retrospectively. According to the operation methods, 121 cases were divided into laparoscopic group ( n=76, laparoscopic high ligation of hernia sac with pneumoperitoneum needle and semi rigid biopsy forceps) and traditional operation group ( n=45, high ligation of traditional inguinal incision hernia sac). The operation time, intraoperative blood loss, incision length, postoperative self activity time and postoperative hospital stay were compared between the two groups; the patients were followed up for 3-21 months, and the proportion of postoperative complications and recurrence cases were compared between the two groups. Results:There was no significant difference in operative time between the two groups ( P=0.335), but the amount of bleeding [(3.8±0.7)ml vs (7.3±1.7)ml, P<0.05], the length of incision [(0.6±0.1)cm vs (1.8±1.2)cm, P<0.05], the time of recovery of self activity [(9.2±2.6)h vs (16.2±4.2)h, P<0.05] and the time of hospitalization [(1.3±0.6)d vs (3.4±1.3)d, P<0.05] in the laparoscopic group were all better than those in the traditional operation group; the proportion of complications and recurrence in the laparoscopic group during the follow-up period was less than that in the traditional operation group (χ 2=5.243, P=0.022). Conclusions:Laparoscopic high ligation of indirect hernia sac in children with veress needle and semi-rigid biopsy forceps has the advantages of small trauma, fast recovery and less postoperative complications, and the equipment is easy to obtain, which is convenient to carry out and promote in basic hospitals.

Nitrogen mustard encapsulated with liposomes was administered to the rabbits with acute experimental serum sickness(AESS). Then the serum levels of anti-BSA antibodies and circulating; immune complex(CIC), CH50, and WBC count were determined. The ACPase activity of spleen macrophages was measured. And the sections of renal tissues, after HE-stained, were studied for the accumulation of CIC and the pathological changes. It was found that liposome-encapsulated nitrogen mustard can increase the macrophage activity and in turn aggravate the renal damages of AESS rabbits.The results suggest that the renal damages of AESS rabbits can immunopatholo-gically be attributed to the increased activity of macrophages.

Objective To obeserve the effects of acute hypervolemic hemodilution(AHH) with hypertonic .sodium chloride hydroxyethyl starch 40(HSH 40) on hemodynamics and fluid balance in patients under general anesthesia.Methods Fifty patients undergoing radical surgery for gastral cancer under general anesthesia were randomly divided into 2 groups with 25 patients each.Acute hypervolemic bemodilution (AHH) was performed with HSH 40 6 ml/kg in group A or with hydroxyethyl statch(HES) 6 ml/kg in group,which was infused within 30 minuts.HR,MAP,CVP were recorded before(T_0),at 30 min (T_1),60 min (T_2) after infusionand and the end of operation (T_3).The amounts of bleeding,HSH 40 and HES and urine output were recorded as well.Results There were no significant diferences in HR and MAP between two groups at all time points.CVP was sighificantly higher at T_1-T_3 than that at To in two groups.The urine output was more in groups A than that in group B(P<0.05).Conclusion AHH with HSH 40 can effectively expand blood vlume and increase urine output in surgical patients under general anesthesia.

Objective　To get the antigen of CD7.Methods　 The extracellular domain of human CD7 was cloned from a plasmid containing the full length of human CD7 cDNA and expressed in pinpoint-xa3 prokaryotic system. Results　 Analysis with SDS-PAGE and Western-blotting showed that the expressed protein could bind to the anti-CD7 mAb specifically and is about 30 000 u in molecular weight. Conclusion　 These results paved the way for preparing anti-CD7 engineering antibody.

Objective To investigate the pathogen of 21 infective endocarditis (IE) cases treated with operation in Shanghai Children's Medical Center from 2007 to 2010.Methods Blood culture,vegetation culture and vegetation PCR assay(target gene to the conserved region V3 in 16SrRNA gene) were detected in 21 IE patients; multiplex PCR amplification of staphylococci for methicillin-resistant staphylococcus was performed.Results Of 21 IE cases,20 cases were detected positive by vegetation PCR with the detection rate of 95.2％,12 IE cases were detected positive by blood culture with the detection rate of 57.1％,2 IE cases were detected positive by vegetation culture with the detection rate of 9.5％.The difference of the positive rates of the three methods was statistically significant (P ＜ 0.0001).The vegetation PCR of one case was actinobacillus actinomycetemcomitans,while the blood culture was haemolysis pasteurell which was inconsistent with the vegetation PCR result.Howerver,the PCR result of colony obtained by blood culture was consistent with vegetation PCR that was confirmed as actinobacillus actinomycetemcomitans.The endocardium PCR results of 11 IE cases were consistent with the results of blood culture.MecA gene was detected by multiplex PCR,which could identify methicillin-resistant staphylococcus quickly,sensitively and accurately and could also effectively identify methicillin resistant staphylococcus aureus,when coupled with femA gene detection,thus glycopeptides antibiotic could be prescribed promptly.All the 21 patients recovered and discharged without infection recurrence in the follow-up.Conclusion Universal primer V3 coupled with multiplex PCR can improve vegetation pathogen detection rate of IE patients and is minimally influenced by antibiotic therapy.Multiplex PCR can be applied for etiological diagnosis of IE patients with indication of surgery and negative blood culture or difficult diagnosis,contributing to post-surgery antibiotics selection and improvement of recovery rate of IE patients.

Objective To study the clinical characteristics, treatment and prognosis of infective endocarditis in children. Methords Clinical data from 83 patients of infective endocarditis admitted from 1998 to 2012 were retrospectively analyzed. Results In a total of 83 patients, there were 53 males and 30 females, and the average age was 6.8±4.6 years. The main clinical characteristics were fever (77.1%) and mild to moderate anemia (71.1%). The C-reaction protein (67.5%), erythrocyte sedimen-tation rate (60.2%), and white blood cell (47.0%) were elevated. Twenty (24.1%) patients had embolism. Blood culture was pos-itive in 56 (67.5%) cases with bacteria mainly being Gram-positive and Streptococcus and Staphylococcus accounted for 89.3%. Vancomycin and other sensitive antibiotics were effective. Neoplasm was detected in 68 cases (82%) by transthoracic echocar-diograerphy. Fifty-ifve (66.2%) patients underwent cardio surgery. Seven patients (8.4%) died. Conclusion In recent years, the distribution of pathogenic bacteria in infective endocarditis had changed. Streptococcus mitis and Staphylococcus aureus has become a major pathogens and need to be treated by vancomycin and other sensitive antibiotics. The detection rate of neoplasm is higher by echocardiography.

Objective To evaluate the role of nuclear factor erythroid 2-related factor 2/antioxidant responsive element (Nrt2/ARE) signaling pathway inthe reduction of myocardial ischemia-reperfusion (I/R) injury by propofol in rats.Methods Sixty adult male Sprague-Dawley rats,weighing 200-240 g,were randomly divided into 5 groups (n =12 each) using a random number table:sham operation group (S group),I/R group,propofol group (P group),propofol + Nrf2 vehicle-plasmid group (PNV group) and propofol + Nrf2 siRNA plasmid group (PNS group).The animals were anesthetized with inhalation of 2％ isoflurane,tracheally intubated and mechanically ventilated.Myocardial I/R was produced by 5 min occlusion of left anterior descending branch of coronary artery followed by 60 min reperfusion.In P,PNV and PNS groups,isoflurane inhalation was stopped after successful intubation and propofol was infused via the caudal vein at 6 mg· kg-1 · h-1 until 30 of reperfusion.At 30 min of propofol infusion,Nrf2 vehicle-plasmid 10 μg (100 μl) was injected intramyocardially before myocardial ischemia in group PNV,and Nrf2 siRNA 10 μg (100 μl) was injected intramyocardially before myocardial ischemia in group PNS.The animals were sacrificed at 60 min of reperfusion and myocardial specimens were taken for determination of the infarct size,apoptosis index,and the expression of Nrf2 and heme oxygenase-1 (HO-1).Results Compared with group S,the infarct size and apoptosis index were significantly increased,and the expression of Nrf2 and HO-1 was up-regulated in I/R and P groups.Compared with group I/R,the infarct size and apoptosis index were significantly decreased,and the expression of Nrf2 and HO-1 was up-regulated in group P.Compared with group P,no significant changes were found in the infarct size,apoptosis index and expression of Nrf2 and HO-1 in group PNV,and the infarct size and apoptosis index were significantly increased,and the expression of Nrf2 and HO-1 was down-regulated in group PNS.Conclusion Nrf2/ARE signaling pathway is involved in the reduction of myocardial I/R injury by propofol in rats.

Objective:To evaluate the efficacy of sugammadex for the reversal of residual neuromuscular blockade after laparoscopic radical gastrectomy in elderly patients.Methods:Sixty patients of both sexes, aged 65-85 yr, with body mass index of 20-26 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, undergoing elective laparoscopic radical gastrectomy under general anesthesia, were divided into 2 groups ( n=30 each) by a random number table method: sugammadex group (S group) and neostigmine group (N group). Rocuronium 0.3-0.6 mg·kg -1·h -1 was intravenously infused during operation, and the muscle relaxation was monitored by a Veryark-TOF monitor, maintaining TOF ratio=0 and counting 1 or 2 after tonic stimulation.Rocuronium was discontinued when the peritoneum was closed.The patients were admitted to the PACU after operation.When the muscle relaxation monitoring T 2 appeared, sugammadex 2 mg/kg was intravenously injected in S group, and neostigmine 0.03 mg/kg plus atropine 0.015 mg/kg was intravenously injected in N group.The tracheal tube was removed after the patient′s consciousness and spontaneous breathing recovered.Before anesthesia (T 1) and 5 and 30 min after tracheal extubation (T 2, 3), arterial blood samples were collected for blood gas analysis, PaO 2 and PaCO 2 were recorded, and ultrasound was used to measure the diaphragm end-inspiratory thickness, end-expiratory thickness and mobility of diaphragm muscle at the above time points.The diaphragm thickening fraction was calculated.The time of T 2 appeared, time of extubation, time of postanesthesia care unit (PACU) stay, postoperative hospital stay, and residual neuromuscular blockade (TOF ratio <0.9) and hypoxemia occurred within 30 min after extubation were recorded.The pulmonary complications within 7 days after operation were recorded. Results:Compared with group N, PaO 2 was significantly increased and PaCO 2 was decreased at T 2, 3, the mobility of diaphragm muscle and diaphragm thickening fraction were increased at T 2, the tracheal extubation time, time of PACU stay and postoperative hospital stay were shortened, the residual neuromuscular blockade and hypoxemia occurred after extubation and incidence of pulmonary complications after operation were decreased ( P<0.05), and no significant change was found in the time of T 2 appeared in group S ( P>0.05). Conclusion:Sugammadex can quickly and effectively reverse the residual neuromuscular blockade after laparoscopic radical gastrectomy, which is helpful for early postoperative recovery in elderly patients.

Objective:To evaluate the effect of operation duration on the pharmacokinetics of desflurane in the patients undergoing tumor resection.Methods:One hundred and fifty patients of both sexes, aged 18-75 yr, with body mass index of 19-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, in whom abnormal preoperative lung function was not found, undergoing elective surgery with general anesthesia from November 2019 to March 2020, were enrolled in this study.Anesthesia was induced with intravenous injection of sufentanil 0.3 μg/kg, cisatracurium besylate 0.2 mg/kg and propofol 2 mg/kg.The patients were tracheally intubated after mechanical ventilation.Anesthesia was maintained with inhalation of desflurane, the vaporizer dial was adjusted to 6% with fresh gas flow rate of 2 L/min, and sufentanil and cisatracurium besylate were intermittently injected intravenously according to the changes in hemodynamics and degree of muscle relaxation during operation.The duration required for the end-tidal concentration of desflurane reaching 0.5 minimum alveolar concentration (MAC), time when the ratio of the end-tidal concentration of desflurane to the pre-set concentration of the vaporizer reached 1/2, time when the ratio of the end-tidal concentration of desflurane to the inhaled concentration reached 1/2, time for the end-tidal concentration of desflurane to decrease to 0.5 MAC and time for the end-tidal concentration to decrease from 0.5 MAC to 0.2 MAC immediately after closing the volatile tank were recorded.The patients were divided into 3 groups according to the operation time: operation time <2 h group (group S), operation time 2-4 h group (group M), and operation time >4 h group (group L). Results:There were no significant differences among the 3 groups in the duration required for the end-tidal concentration of desflurane reaching 0.5 MAC, time when the ratio of the end-tidal concentration of desflurane to the pre-set concentration of the vaporizer reached 1/2, time when the ratio of the end-tidal concentration of desflurane to the inhaled concentration reached 1/2, time for the end-tidal concentration of desflurane to decrease to 0.5 MAC and time for the end-tidal concentration to decrease from 0.5 MAC to 0.2 MAC immediately after closing the vaporizer ( P>0.05). Conclusion:Operation duration does not affect the pharmacokinetics of desflurane in the patients undergoing tumor resection.

Objective To explore the feasibility of assessments of functional and environmental factors in children with Duchenne mus-cular dystrophy (DMD) under the frame of International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY). To execute family intervention and to evaluate its effects. Methods A 6-year-and-5-month-old boy with DMD was enrolled to the study. Functional and environmental factors were assessed with the North Star Ambulatory Assessment (NSAA), time tests, hand-held dyna-mometry assessment, body mass index and family interview. Plans of family intervention were settled and executed for one year and at the end of intervention, the boy received all the above assessments to compare the effects of intervention. Results After one-year family inter-vention, the muscle strength was improved or maintained in most muscles except abductors of hip and the body mass index did not change. For the activities, the scores of NSAA increased and maintained, and the result of time tests improved. Otherwise, attitude and execution of parents were improved. Conclusion It is feasible to execute family intervention under the frame of ICF-CY in children with DMD. Both children and their family may benefit from the intervention.